ABSTRACT
La anatomía normal de las arterias coronarias incluye una serie de variantes respecto a su origen, distribución y recorrido, que hacen que no existan 2 pacientes con coronarias exactamente iguales. La arteria descendente anterior puede tener variantes anatómicas que no afectan el aporte normal de sangre al territorio miocárdico correspondiente. En nuestros 25 años de trabajo y más de 11,000 coronariografías realizadas, sólo habíamos encontrado un paciente con un doble sistema, tipo IV, de la arteria descendente anterior. En este artículo mostramos el caso de una paciente con la anomalía coronaria descrita que presentaba, además, una estenosis severa de la arteria circunfleja que fue tratada exitosamente por vía percutánea. También, se propone una actualización de la clasificación de Spindola-Franco, donde se mantienen los 4 tipos originales y se añaden 7 variantes anatómicas o subtipos.
The normal anatomy of coronary arteries includes a kind of variants with regard to its origin, distribution and route, which makes that 2 patients do not have coronary arteries exactly alike. Left anterior descending artery could have anatomical variations that do not affect the normal supply of blood to the corresponding myocardial territory. In our 25 years of experience, and more than 11,000 coronary angiographies, we have found only one patient with a type IV Classification; dual left anterior descending coronary artery. In this article we show the case of a patient with the described coronary anomaly, presenting a severe stenosis of the circumflex artery which was successfully treated percutaneously. Besides, a proposal for updating the classification of Spindola-Franco is made, where the 4 types previously described were kept invariable, and 7 anatomical variants or subtypes were added.
Subject(s)
Aged , Female , Humans , Angioplasty/methods , Coronary Vessel Anomalies/classification , Coronary Vessel Anomalies/surgeryABSTRACT
La arteria coronaria descendente anterior es la arteria coronaria con el trayecto más constante; sin embargo en algunas ocasiones puede presentarse un sistema doble. Se reporta y se realiza una revisión de la literatura de un caso de un paciente con arteria coronaria descendente anterior doble tipo 1, con bloqueo de rama izquierda pero sin lesiones ateromatosas significativas.
The left anterior descending coronary artery has one of the most constant anatomy course of all coronary arteries. Rarely however, interventional cardiologists might be facing with a dual left anterior descending artery during routine angiography. A case of a patient presenting with left bundle branch block and a coronary angiography showing a rare anatomic variant of a type 1, dual left anterior descending coronary artery is reported. The available literature was also reviewed.
Subject(s)
Arteries , Bundle-Branch Block , Vascular MalformationsABSTRACT
Se presenta el caso clÃnico de un paciente exfumador (sin otro antecedente), que después de una situación de estrés comenzó a experimentar, por más de 20 minutos, dolor precordial intenso, opresivo y retroesternal, irradiado hacia el hombro izquierdo, acompañado de diaforesis. Sobre la base de los resultados de la prueba de esfuerzo y ecografÃa, se realizó cateterismo cardÃaco, lo cual permitió diagnosticar una anomalÃa en la arteria coronaria izquierda, dada por el nacimiento de la descendente anterior de la coronaria derecha. La obstrucción de ambas arterias fue eliminada exitosamente mediante angioplastia y colocación de una endoprótesis vascular.
The case report of a former smoker is presented who (without any other history) after a stressful situation began to experience during more than 20 minutes a severe retrosternal and oppressive precordial pain irradiated to the left shoulder, accompanied by diaphoresis. Taking into account the results of the stress test and ultrasonography, cardiac catheterization was performed that allowed to diagnose an abnormality in the left coronary artery, which consisted in the birth of the anterior descending artery from right coronary artery. The obstruction of both arteries was successfully removed by angioplasty and vascular stent placement.
Subject(s)
Humans , Male , Adult , Angioplasty, Balloon, Coronary , Blood Vessel Prosthesis , Cardiac CatheterizationABSTRACT
Avaliar a incidência de oclusäo de ramos secundários em pacientes com lesäo única da artéria descendente anterior, em que a angioplastia coronária foi aplicada pela primeira vez e com sucesso. Duzentos e treze casos com ramos secundários em pacientes com lesäo única da ar considerados " em risco" por estarem envolvidos na lesäo (grupo I - GI; 85 casos - 39,9%); ou por terem sido atingidos pela insuflaçäo do baläo (grupo II - GII, 128 casos - 61,5%). Corresponderam a: GI - 54 ramos septais (S) e 31 ramos diaggonais (Dg), sendo que 36% tinham evidência angiográfica de doença ostial; GII - 77 S e 51 Dg, com 7,8% de doença ostial. Oclusäo de 7 (3,3%) ramos secundários " em "em risco", 4 (4,7%) do GI e 3 (2,3%) do GII. Na evoluçäo clínica destes 7 casos observaram-se angina de peito em 57% e alteraçöes isquêmicas discretas ao eletrocardiograma em 28.6%. Näo houve qualquer alteraçäo enzímica. A oclusäo foi clinicamente silenciosa em 43% dos casos. A oclusäo de ramos secundários é de baixa incidência, ocorre com maior freqüência nos septais, que nascem da lesäo e nos que têm doença ostial, sendo silenciosa em quase metade dos pacientes ou acompanhada de alteraçeos isquêmicas.
Purpose: To evaluate the incidence and clinical presentation of the occlusion of such secondary branches in patients with single vessel coronary artery disease in the left anterior descending artery, who underwent a first elective and successful PTCA. Material and Methods: Two hundred and thirteen side branches of 121 patients considered to be at risk. They were divided into group I (GI85 side branches, 39.9%), if they originated from the atherosclerotic site; and group II (GII120 side branches, 61.5%), if their origin would be involved during the balloon inflation. In the GI there were 54 septal branches and 3.1 diagonal branches, and 36& had angiographic evidence of ostium disease. GII was constituted by 77 septal and 51 diagonal branches, and 7.8% of them had evidence of ostium disease. Results: Seven side branches (3.3%) at risk occluded, 4 from GI (4.7%) and 3 (2.3%) from GII. As for the clinical presentation, 57% of them had angina, where as 28.6% showed minor abnormalities in the ECG. No patient elevated its serum CK-MB, and silent occlusion cccurred in 43% if them. Conclusion: Occlusion of side branches is a low incidence phenomenon, which happens more often in septal branches with ostium disease that originates from the atherosclerotic site; that about half of the patient had silent occlusion (43%) or mild ischemic manifestations